Semin Neurol 2008; 28(5): 645-656
DOI: 10.1055/s-0028-1105975
© Thieme Medical Publishers

Ischemic Stroke and ICU Care

Rafael H. Llinas1
  • 1Department of Neurology, Johns Hopkins Bayview Medical Center, Baltimore, Maryland
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Publikationsverlauf

Publikationsdatum:
29. Dezember 2008 (online)

ABSTRACT

Acute ischemic stroke is a common disorder with a significant impact on morbidity and mortality in the United States. The number of interventions for acute stroke patients has increased over the past 15 years and patients increasingly require intensive care. There are several issues that are specific to ischemic stroke patients in intensive care unit (ICU) settings, including the care of the postthrombolytic stroke patient, respiratory issues in stroke care, evaluation of worsening or change in neurological status, and attention to factors that affect the ischemic penumbra. The management of the stroke patient in the critical care setting is discussed in this article.

REFERENCES

  • 1 Govan L, Langhorne P, Weir C J. Does the prevention of complications explain the survival benefit of organized inpatient (stroke unit) care? Further analysis of a systematic review.  Stroke. 2007;  38(9) 2536-2540
  • 2 Adams Jr H P, Del Zoppo G, Alberts M J et al.. Guidelines for the Early Management of Adults with Ischemic Stroke: A Guideline from the American Heart Association/American Stroke Association Stroke Council, Clinical Cardiology Council, Cardiovascular Radiology and Intervention Council, and the Atherosclerotic Peripheral Vascular Disease and Quality of Care Outcomes in Research Interdisciplinary Working Groups.  Stroke. 2007;  38(5) 1655-1711
  • 3 Sulter G, Elting J W, Langedijk M, Maurits N M, De Keyser J. Admitting acute ischemic stroke patients to a stroke care monitoring unit versus a conventional stroke unit: a randomized pilot study.  Stroke. 2003;  34(1) 101-104
  • 4 Gorter P M, Olijhoek J K, van der Graaf Y, Algra A, Rabelink T J, Visseren F LJ. Prevalence of the metabolic syndrome in patients with coronary heart disease, cerebrovascular disease, peripheral arterial disease or abdominal aortic aneurysm.  Atherosclerosis. 2004;  173(2) 363-369
  • 5 Stoffers H EJH, Rinkens P ELM, Kester A DM, Kaiser V, Knottnerus J A. The prevalence of asymptomatic and unrecognized peripheral arterial occlusive disease.  Int J Epidemiol. 1996;  25(2) 282-290
  • 6 Briggs D E, Felberg R A, Malkoff M D, Bratina P, Grotta J C. Should mild or moderate stroke patients be admitted to an intensive care unit?.  Stroke. 2001;  32(4) 871-876
  • 7 Diringer M N, Edwards D F. Admission to a neurologic/neurosurgical intensive care unit is associated with reduced mortality rate after intracerebral hemorrhage.  Crit Care Med. 2001;  29(3) 635-640
  • 8 Suarez J I, Zaidat O O, Suri M F et al.. Length of stay and mortality in neurocritically ill patients: impact of a specialized neurocritical care team.  Crit Care Med. 2004;  32(11) 2311-2317
  • 9 Mirski M A, Chang C WJ, Cowan R. Impact of a neuroscience intensive care unit on neurosurgical patient outcomes and cost of care: Evidence-based support for an intensivist-directed specialty ICU model of care.  J Neurosurg Anesthesiol. 2001;  13(2) 83-92
  • 10 Hemphill J C, Bleck T, Carhuapoma J R et al.. Is neurointensive care really optional for comprehensive stroke care?.  Stroke. 2005;  36(11) 2344-2345
  • 11 Hill M D, Barber P A, Takahashi J, Demchuk A M, Feasby T E, Buchan A M. Anaphylactoid reactions and angioedema during alteplase treatment of acute ischemic stroke.  CMAJ. 2000;  162(9) 1281-1284
  • 12 Mills G C, Arntfield R T, Sedran R J. Acute allergic reaction due to the administration of fibrinolytic therapy for ST-segment elevation myocardial infarction: Case report and discussion.  CJEM. 2003;  5(6) 421-423
  • 13 Rudolf J, Grond M, Prince W S, Schmulling S, Heiss W D. Evidence of anaphylaxy after alteplase infusion.  Stroke. 1999;  30(5) 1142-1143
  • 14 Molinaro G, Gervais N, Adam A. Biochemical basis of angioedema associated with recombinant tissue plasminogen activator treatment: an in vitro experimental approach.  Stroke. 2002;  33(6) 1712-1716
  • 15 Hill M D, Lye T, Moss H et al.. Hemi-orolingual angioedema and ACE inhibition after alteplase treatment of stroke.  Neurology. 2003;  60(9) 1525-1527
  • 16 Mueller H S, Rao A K, Forman S A. Thrombolysis in myocardial infarction (TIMI): comparative studies of coronary reperfusion and systemic fibrinogenolysis with two forms of recombinant tissue-type plasminogen activator.  J Am Coll Cardiol. 1987;  10(3) 479-490
  • 17 Topol E J, Morris D C, Smalling R W et al.. A multicenter, randomized, placebo-controlled trial of a new form of intravenous recombinant tissue-type plasminogen activator (activase) in acute myocardial infarction.  J Am Coll Cardiol. 1987;  9(6) 1205-1213
  • 18 Marler J R. Tissue plasminogen activator for acute ischemic stroke.  N Engl J Med. 1995;  333(24) 1581-1587
  • 19 Lewandowski C A, Frankel M, Tomsick T A et al.. Combined intravenous and intra-arterial r-TPA versus intra-arterial therapy of acute ischemic stroke emergency management of stroke (EMS) bridging trial.  Stroke. 1999;  30(12) 2598-2605
  • 20 Broderick J P. The interventional management of stroke (IMS) II study.  Stroke. 2007;  38(7) 2127-2135
  • 21 Del Zoppo G J, Higashida R T, Furlan A J, Pessin M S, Rowley H A, Gent M. PROACT: a phase II randomized trial of recombinant pro-urokinase by direct arterial delivery in acute middle cerebral artery stroke.  Stroke. 1998;  29(1) 4-11
  • 22 Furlan A, Higashida R, Wechsler L et al.. Intra-arterial prourokinase for acute ischemic stroke. The PROACT II study: a randomized controlled trial.  JAMA. 1999;  282(21) 2003-2011
  • 23 Kremen S A, Wu M N, Ovbiagele B. Hemopericardium following intravenous thrombolysis for acute ischemic stroke.  Cerebrovasc Dis. 2005;  20(6) 478-479
  • 24 Bushnell C D, Phillips-Bute B G, Laskowitz D T, Lynch J R, Chilukuri V, Borel C O. Survival and outcome after endotracheal intubation for acute stroke.  Neurology. 1999;  52(7) 1374-1381
  • 25 Grotta J. Elective intubation for neurologic deterioration after stroke.  Neurology. 1995;  45(4) 640-644
  • 26 Steiner T, Mendoza G, De Georgia M, Schellinger P, Holle R, Hacke W. Prognosis of stroke patients requiring mechanical ventilation in a neurological critical care unit.  Stroke. 1997;  28(4) 711-715
  • 27 Duke B J, Ryu R K, Brega K E, Coldwell D M. Traumatic bilateral jugular vein thrombosis: Case report and review of the literature.  Neurosurgery. 1997;  41(3) 680-683
  • 28 Kotani J, Nitta K, Sakuma Y, Sugioka S, Fujita N, Ueda Y. Effects of bilateral jugular vein ligation on intracranial pressure and cerebrospinal fluid outflow resistance in cats.  Br J Oral Maxillofac Surg. 1992;  30(3) 171-173
  • 29 Toung T JK, Miyabe M, McShane M J, RCSI F, Rogers M C, Traystman R J. Effect of PEEP and jugular venous compression on canine cerebral blood flow and oxygen consumption in the plead elevated position.  Anesthesiology. 1988;  68 53-58
  • 30 Morfit H M, Cleveland Jr H. Permanent increased intracranial pressure following unilateral radical neck dissection.  AMA Arch Surg. 1958;  76(5) 713-719
  • 31 Schwarz S, Georgiadis D, Aschoff A, Schwab S. Effects of body position on intracranial pressure and cerebral perfusion in patients with large hemispheric stroke.  Stroke. 2002;  33(2) 497-501
  • 32 Hung O R, Hare G M, Brien S. Head elevation reduces head-rotation associated increased ICP in patients with intracranial tumors.  Can J Anaesth. 2000;  47(5) 415-420
  • 33 Caricato A, Conti G, Francesco Della Corte M D et al.. Effects of PEEP on the intracranial system of patients with head injury and subarachnoid hemorrhage: The role of respiratory system compliance.  J Trauma. 2005;  58(3) 571-576
  • 34 Georgiadis D, Schwarz S, Baumgartner R, Veltkamp R, Schwab S. Influence of positive end-expiratory pressure on intracranial pressure and cerebral perfusion pressure in patients with acute stroke.  Stroke. 2001;  32(9) 2088-2092
  • 35 Muench E, Bauhuf C, Roth H et al.. Effects of positive end-expiratory pressure on regional cerebral blood flow, intracranial pressure, and brain tissue oxygenation.  Crit Care Med. 2005;  33(10) 2367-2372
  • 36 Shapiro H M, Marshall L F. Intracranial pressure responses to PEEP in head-injured patients.  J Trauma. 1978;  18(4) 254-256
  • 37 Stewart A R, Finer N N, Peters K L. Effects of alterations of inspiratory and expiratory pressures and inspiratory/expiratory ratios on mean airway pressure, blood gases, and intracranial pressure.  Pediatrics. 1981;  67(4) 474-481
  • 38 Weimar C, Mieck T, Buchthal J, Ehrenfeld C E, Schmid E, Diener H C. Neurologic worsening during the acute phase of ischemic stroke.  Arch Neurol. 2005;  62(3) 393-397
  • 39 Papazian L, Albanese J, Thiron X, Perrin G, Durbec O, Martin C. Effect of bolus doses of midazolam on intracranial pressure and cerebral perfusion pressure in patients with severe head injury.  Br J Anaesth. 1993;  71(2) 267-271
  • 40 Lyden P, Shuaib A, Ng K et al.. Clomethiazole Acute Stroke Study in ischemic stroke (CLASS-I): final results.  Stroke. 2002;  33(1) 122-128
  • 41 Wahlgren N G, Ranasinha K W, Rosolacci T et al.. Clomethiazole acute stroke study (CLASS) results of a randomized, controlled trial of clomethiazole versus placebo in 1360 acute stroke patients.  Stroke. 1999;  30(1) 21-28
  • 42 Benbadis S R, Sila C A, Cristea R L. Mental status changes and stroke.  J Gen Intern Med. 1994;  9(9) 485-487
  • 43 Saxena R, Lewis S, Berge E, Sandercock P AG, Koudstaal P J. Risk of early death and recurrent stroke and effect of heparin in 3169 patients with acute ischemic stroke and atrial fibrillation in the international stroke trial.  Stroke. 2001;  32(10) 2333-2337
  • 44 Burn J, Dennis M, Bamford J, Sandercock P, Wade D, Warlow C. Epileptic seizures after a first stroke: the Oxfordshire community stroke project.  BMJ. 1997;  315(7122) 1582-1587
  • 45 Arboix A, Garcia-Eroles L, Massons J B, Oliveres M, Comes E. Predictive factors of early seizures after acute cerebrovascular disease.  Stroke. 1997;  28(8) 1590-1594
  • 46 Carrera E, Michel P, Despland P A et al.. Continuous assessment of electrical epileptic activity in acute stroke.  Neurology. 2006;  67(1) 99-104
  • 47 Rumbach L, Sablot D, Berger E, Tatu L, Vuillier F, Moulin T. Status epilepticus in stroke report on a hospital-based stroke cohort.  Neurology. 2000;  54(2) 350-354
  • 48 Rao M A, Misra M, Duara R, Jayakumar K, Neelakandhan K S. Acute phenytoin toxicity mimicking stroke following cardiopulmonary bypass.  Indian J Thoracic Cardiovascular Surgery. 2006;  22(1) 19-21
  • 49 Ryvlin P, Montavont A, Nighoghossian N. Optimizing therapy of seizures in stroke patients.  Neurology. 2006;  67(suppl 4) S3
  • 50 Semplicini A, Maresca A, Boscolo G et al.. Hypertension in acute ischemic stroke: a compensatory mechanism or an additional damaging factor?.  Arch Intern Med. 2003;  163(2) 211-216
  • 51 Fischberg G M, Lozano E, Rajamani K, Ameriso S, Fisher M J. Stroke precipitated by moderate blood pressure reduction.  J Emerg Med. 2000;  19(4) 339-346
  • 52 Leonard M B, Kasner S E, Feldman H I, Schulman S L. Adverse neurologic events associated with rebound hypertension after using short-acting nifedipine in childhood hypertension.  Pediatr Emerg Care. 2001;  17(6) 435-437
  • 53 Rupp H, Maisch B, Brilla C G. Drug withdrawal and rebound hypertension: Differential action of the central antihypertensive drugs moxonidine and clonidine.  Cardiovasc Drugs Ther. 1996;  10 251-262
  • 54 Geyskes G G, Boer P, Dorhout Mees E J. Clonidine withdrawal. Mechanism and frequency of rebound hypertension.  Br J Clin Pharmacol. 1979;  7(1) 55-62
  • 55 Frewin D B, Penhall R K. Rebound hypertension after sudden discontinuation of methyldopa therapy.  Med J Aust. 1977;  1(18) 659
  • 56 Keim H J, Drayer J I, Case D B et al.. A role for renin in rebound hypertension and encephalopathy after infusion of saralasin acetate (Sar1-Ala8-angiotensin II).  N Engl J Med. 1976;  295(21) 1175-1177
  • 57 Rordorf G, Koroshetz W J, Ezzeddine M A, Segal A Z, Buonanno F S. A pilot study of drug-induced hypertension for treatment of acute stroke.  Neurology. 2001;  56(9) 1210-1213
  • 58 Shah Q A, Patel S, Qureshi A I. Induced hypertension in patients with partial recanalization after intra-arterial thrombolysis for acute ischemic stroke.  J Neurosurg Anesthesiol. 2008;  20(2) 154-155
  • 59 Hillis A E, Ulatowski J A, Barker P B et al.. A pilot randomized trial of induced blood pressure elevation: effects on function and focal perfusion in acute and subacute stroke.  Cerebrovasc Dis. 2003;  16(3) 236-246
  • 60 Jørgensen H S, Nakayama H, Raaschou H O, Olsen T S. Effect of blood pressure and diabetes on stroke in progression.  Lancet. 1994;  344(8916) 156-159
  • 61 Azzimondi G, Bassein L, Nonino F et al.. Fever in acute stroke worsens prognosis: a prospective study.  Stroke. 1995;  26(11) 2040-2043
  • 62 Boysen G, Christensen H. Stroke severity determines body temperature in acute stroke.  Stroke. 2001;  32(2) 413-417
  • 63 Castillo J, Davalos A, Marrugat J, Noya M. Timing for fever-related brain damage in acute ischemic stroke.  Stroke. 1998;  29(12) 2455-2460
  • 64 Busto R, Dietrich W D, Globus M Y, Valdes I, Scheinberg P, Ginsberg M D. Small differences in intraischemic brain temperature critically determine the extent of ischemic neuronal injury.  J Cereb Blood Flow Metab. 1987;  7(6) 729-738
  • 65 Krieger D W, De Georgia M A, Abou-Chebl A et al.. Cooling for acute ischemic brain damage (COOL AID): an open pilot study of induced hypothermia in acute ischemic stroke.  Stroke. 2001;  32(8) 1847-1854
  • 66 De Georgia M A, Krieger D W, Abou-Chebl A et al.. Cooling for acute ischemic brain damage (COOL AID): a feasibility trial of endovascular cooling.  Neurology. 2004;  63(2) 312-317
  • 67 Kasner S E, Wein T, Piriyawat P et al.. Acetaminophen for altering body temperature in acute stroke: a randomized clinical trial.  Stroke. 2002;  33(1) 130-134
  • 68 Bruno A, Levine S R, Frankel M R et al.. Admission glucose level and clinical outcomes in the NINDS rt-PA stroke trial.  Neurology. 2002;  59(5) 669-674
  • 69 Capes S E, Hunt D, Malmberg K, Pathak P, Gerstein H C. Stress hyperglycemia and prognosis of stroke in nondiabetic and diabetic patients: a systematic overview.  Stroke. 2001;  32(10) 2426-2432
  • 70 Walters M R, Weir C J, Lees K R. A randomized, controlled pilot study to investigate the potential benefit of intervention with insulin in hyperglycaemic acute ischaemic stroke patients.  Cerebrovasc Dis. 2006;  22(2–3) 116-122
  • 71 Yip P K, He Y Y, Hsu C Y et al.. Effect of plasma glucose on infarct size in focal cerebral ischemia-reperfusion.  Neurology. 1991;  41(6) 899-905
  • 72 Lin B, Ginsberg M, Busto R. Hyperglycemic exacerbation of neuronal damage following forebrain ischemia: Microglial, astrocytic and endothelial alterations.  Acta Neuropathol. 1998;  96(6) 610-620

Rafael H LlinasM.D. 

Department of Neurology, Johns Hopkins Bayview Medical Center, Neurology B122b

4940 Eastern Avenue, Baltimore, MD 21224

eMail: rllinas@jhmi.edu

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